Splenomegaly--an insensitive sign of portal hypertension.
The prevalence of splenomegaly associated with portal hypertension was examined in a consecutive population of 111 patients who had portal hypertension diagnosed using specific endoscopic, sonographic, and Doppler signs. Splenic size was measured objectively via its cranio-caudal length on coronal section using ultrasound and by clinical examination. Sonographically, 52% of patients had a definitely large spleen and 35% a spleen less than one standard deviation from the normal mean, while a further 13% had equivocal splenomegaly. Only 52% of patients had splenomegaly on clinical assessment. Splenomegaly was less common in patients with alcoholic (41% definite, 15% equivocal) than in those with non-alcoholic liver disease (66% definite, 17% equivocal, p = 0.02) and splenic length was significantly smaller in alcoholic patients (12.7 +/- 0.5 cm) compared to patients with either non-alcoholic liver disease (15.0 +/- 0.6 cm, p = 0.003) or portal hypertension due to vascular occlusive diseases (16.5 +/- 2.0 cm, p = 0.006). Splenomegaly, whether assessed sonographically or clinically, is an insensitive sign of portal hypertension and its absence cannot be used as a negative predictor of the presence of portal hypertension in patients with chronic liver disease.
Gibson
P R
PR
Department of Medicine, Royal Melbourne Hospital, Vic., Australia.
Gibson
R N
RN
Ditchfield
M R
MR
Donlan
J D
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008108:Liver Diseases, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D013163:Splenomegaly / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography